Our blogger
Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant.
See her current articles.

Send us your comments

Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at .

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

The Center for Medicare and Medicaid Services (CMS) just released information on drug claims for the 25 million Medicare beneficiaries enrolled in Medicare Part D. The Medicare Part D Data Final Rule, published in May 2008 called for the compilation of this claims data (see Final Rule fact sheet) for program monitoring, research, and quality improvement.

Below are some highlights on beneficiaries’ experiences with Part D costs and benefits extracted from this 2006-2007 claims data and presented at CMS’ Medicare Prescription Drug Benefit (Part D) Symposium on October 30, 2008. Additional information on the Medicare Part D Data Final Rule and access to the power point presentations from the symposium will be available next week on CMS’ website.

Beneficiary Experience

Part D Costs and Utilization per Beneficiary

Based on 2006 data, the average monthly cost per enrolled beneficiary (including both beneficiary out-of-pocket costs and plan costs) was $203. The average cost was higher among stand-alone prescription drug plans (PDPs) ($233) than Medicare Advantage prescription drug plans (MA-PDs) ($135). It was also slightly higher among females ($209) than males ($193), and higher among enrollees with the low-income subsidy (LIS) ($277) than non-LIS enrollees ($147).

The average number of prescriptions per enrolled beneficiary per month was 3.2. The average number of prescriptions per enrolled beneficiary was slightly higher among PDPs (3.5) than MA-PDs (2.5), slightly higher among females (3.5) than males (2.8), and higher among the LIS (4.1) than the non-LIS enrollees (2.6).

According to CMS data, a smaller percentage of total enrollees were fully exposed to the Part D donut hole coverage gap (10.9%) as opposed to the 26% of beneficiaries reported in the recent Kaiser Family Foundation report. This smaller percentage was calculated after excluding all LIS beneficiaries as well as those non-LIS beneficiaries with some type of coverage in the gap.

When taking out these exclusions, however, CMS data actually shows a greater percentage than the KFF report – 31.7% of all enrolled beneficiaries – who fall into the donut hole.

Also, CMS found it took affected beneficiaries an average of 6 months from enrollment time to reach the donut hole. The average time in the donut hole was about 4 months. In both years, on average, LIS enrollees reached the donut hole sooner than non-LIS enrollees and PDP enrollees reached the donut hole sooner than MA-PD enrollees.

In addition, only 8.8% of all Part D enrollees reached the catastrophic coverage phase in 2007, and the vast majority were LIS beneficiaries.